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CHECK OFF LIST FOR ISSUANCE OF PERMITS <br /> FOR OFFICE USE ONLY <br /> ADDRESS OR LEGAL: LO 3(- /w S1,(-u2t Q(Z —PID: <br /> DESCRIPTION OF WORK: S 'C�' _ <br /> ___ - <br /> ZONING --------------- ------------------------ 3 <br /> ZONING-REVIEW-BY.- DATE APPROVED: <br /> BUILDING REVIEW BY: Nz, DATE APPROVED: <br /> --------------------- <br /> FEES TO BE CHARGED: Misc. Fees Calculated By: <br /> PERMIT YesNo <br /> PLAN REVIEW Yes No SEWER CONNECTION <br /> STATE SURCHARGE Yes�i' No WATER CONNECTION <br /> INVESTIGATION FEE Yes No L,� PARR FEE <br /> SAC Yes No (% SITE INSPECTION <br /> Number-of-SAC- ------------------- <br /> UnitsOTHER-(specify)------ <br /> ------------------- <br /> ZONING CHECK LIST Zoning District: �/- 1 <br /> Fire Department: Post Office: /e- ,-^,r� School District: 0 <br /> 1-4 <br /> Lot Area: 12, 6, 0 Width: w Depth: <br /> Survey Submitted: Yes Nom_ Date of Survey: <br /> Proposed Setbacks: Right Side: ( ; 4 <br /> Front (-Larke) : S t�� �i <br /> Rear (Str t) : / s + Left Side: Z 1 <br /> Adjacent Structures: Wetland: N /4 <br /> Building Height: Def. Hgt. - Peak Hgt. <br /> Avg. Setback: /yt4 Lot Coverage: <br /> Existing Proposed <br /> Hardcover: 0-75 ' <br /> 75-250 ' <br /> 250-500 ' Z 3 <br /> 500-1000 ' <br /> Hardcover Variance Required: Yes No //< Date of Council Approval: <br /> Grading: Staff proval Dat By: Council Approval Date: <br /> Septic: Staff p roval Date B <br /> Zoning File:# R solution Resolution Date: <br /> REMARKS (in ho se) : <br />